Prolonged migraine aura resembling ischemic stroke following CoronaVac vaccination: an extended case series

BackgroundAfter the initiation of the COVID-19 vaccination program in Thailand, thousands of patients have experienced unusual focal neurological symptoms. We report 8 patients with focal neurological symptoms after receiving inactivated virus vaccine, CoronaVac.Case seriesPatients were aged 24–48 years and 75% were female. Acute onset of focal neurological symptoms occurred within the first 24 h after vaccination in 75% and between 1-7d in 25%. All presented with lateralized sensory deficits, motor deficits, or both, of 2–14 day duration. Migraine headache occurred in half of the patients. Magnetic resonance imaging of the brain during and after the attacks did not demonstrate any abnormalities suggesting ischemic stroke. All patients showed moderately large regions of hypoperfusion and concurrent smaller regions of hyperperfusion on SPECT imaging while symptomatic. None developed permanent deficits or structural brain injury.DiscussionsHere, we present a case series of transient focal neurological syndrome following Coronavac vaccination. The characteristic sensory symptoms, history of migraine, female predominant, and abnormal functional brain imaging without structural changes suggest migraine aura as pathophysiology. We propose that pain related to vaccine injection, component of vaccine, such as aluminum, or inflammation related to vaccination might trigger migraine aura in susceptible patients.Supplementary InformationThe online version contains supplementary material available at 10.1186/s10194-022-01385-0.     

The First 10 Thrombolysis for Acute Ischemic Stroke in Lao People's Democratic Republic under Teleconsultation from Thailand

Background: Acute ischemic stroke patients in Lao People's Democratic Republic (Lao PDR) are unable to access the intravenous thrombolytic therapy using recombinant tissue plasminogen activator (rtPA) due to various reasons. Aims: This study aimed to evaluate the feasibility and safety of thrombolytic therapy administration at Mittaphab Hospital, Lao PDR under the international telestroke consultation system from King Chulalongkorn Memorial Hospital, Thailand. Methods: Acute ischemic stroke patients who presented at Mittaphab Hospital within 4.5 hours after the onset and received thrombolytic therapy between December 2016 and June 2017 were studied. An immediate real time teleconsultation with 24 hours availability between neurologists at Mittaphab hospital and the Chulalongkorn stroke team was performed in all cases for patient evaluation and decision for thrombolytic treatment. Results: There were 205 patients with acute stroke, 28 patients (14%) arrived at the hospital within 4.5 hours after the onset. Ten patients (5%) were eligible for intravenous rtPA. The mean duration from onset to hospital arrival was 122.50 minutes and the mean door to needle time was 108 minutes. The mean National Institute of Health stroke scale (NIHSS) before thrombolysis was 10. At 90 days, the mean NIHSS was 3 and the mean mRS was 2. Seventy percent of patients had good outcome (mRS ≤2). Only one patient developed massive cerebral infarction. None of the patient developed symptomatic intracerebral hemorrhage or major bleedings. Conclusions: Telestroke consultation from Thailand can facilitate the thrombolytic therapy for acute ischemic stroke patients in Lao PDR.     

Assessment of the quality of leprosy services from the clients' perspective in Thailand

To assess the quality of the leprosy service in health facilities from the clients' perspective, qualitative data collection methods, i.e. semi-structured interviews, focus group discussions (FGDs) and priority cards, were conducted in six health facilities located in all regions of Thailand. A total of 29 patients were interviewed and three focus group discussions involving 20 patients were carried out. In addition, six health staff and six community members were interviewed. The results show that patients delayed months to years before they went to a public health facility. This is due to the poor knowledge about leprosy. Most of the interviewed patients tried to get rid of the skin symptoms at home, using topical medicated cream or herbs. Distance was not regarded as a problem, because most patients go to nearby district hospitals. In district hospitals misdiagnosis is still common. More than half of leprosy patients said they did not receive any information about leprosy before they were diagnosed. Travel costs seem to cause problems for a few poor and aged patients who needed someone to accompany them. Patients at district and provincial hospitals complained that the waiting times to consult staff were too long. In most health facilities, privacy during examinations was not adequate. Patients placed a priority on health staff being friendly and respectful to them. When patients were asked to list their priorities of the quality of services, they considered the attitude of health staff, low costs to go to the leprosy services, adequate attention to POD and adequate information to leprosy patients on their disease, as their top four items. Important recommendations resulting from the study were: (1) health education to the public has to be strengthened; (2) training of health staff to minimize doctors' delay; (3) good attitude of health staff towards leprosy patients should be sustained; and (4) leprosy services in district and provincial hospitals should be improved as a one-stop service for leprosy patients.